1. HEALTH INSURANCE COVERAGE
AMONG SAME-SEX COUPLES:
DISPARITIES AND TRENDS UNDER DOMA
Gilbert Gonzales, MHA
University of Minnesota
American Public Health Association
Social Contexts and Social Determinants of LGBT Health
Monday, November 4, 2013

2. Disclosure Statement
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No Second level to disclose
relationships
Third level
Fourth level
Fifth level
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3. Acknowledgments
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Co-Authors:
Second level Department of Sociology
Ryan Moltz,
Third level
Miriam King, Minnesota Population Center
Fourth level
Fifth Minnesota
University oflevel
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4. State marriage policy rapidly
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Second level
Third level
Fourth level
Fifth level
Source: National Conference of State Legislatures
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5. Why to edit Master matter?
Clickdoes marriage title style
Most to edit Master covered
Click Americans aretext stylesthrough a family member’s
employer health plan
Second level
 “Legal”
Third level spouse
Fourth level
 Dependent children
Fifth level
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6. More to edit Master title style
Click employers extending insurance
Large employers (500+ employees) offering same-sex domestic partner
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benefits
Second level
46% 47%
Third level
39% 39%
Fourth level
Fifth level
16%
19%
21%
24%
34% 34%
27%
29%
12%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Source: 2012 Mercer National Survey of Employer-Sponsored Health Plans
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7. Federal edit Master title style
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Employee Retirement Income Security Act (ERISA)
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 Health insurance coverage is mandated for same-sex spouses
Second level
in 16 states, but state mandates only affect fully-insured
Third level
employers (42% employees)
Fourth level
 Self-insuredlevel
Fifth employers are regulated by the federal
government, not states
Defense of Marriage Act (DOMA), 1996-2013
 Did not recognize same-sex unions at the federal level
 Insurance for same-sex spouses treated as taxable income
(adds $1,000 annually)
Source: Badget MVL. The economic value of marriage for same-sex couples. Drake Law Review. 2010.
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8. The latest trend
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Droppingedit Master text styles state marriage reform
Click to domestic partners following
Second level
Third level
Fourth level
Fifth level
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9. Research Questions
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Is private Master insurance
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improving for same-sex couples?
Second level
Third level
Fourth level
Fifth level
Are there differences in health insurance
coverage between married and unmarried
same-sex couples?
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10. Data
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Nationaledit Master text styles (NHIS), 1997-2012
Click to Health Interview Survey
Second level
Non-elderly (25-64 years) partnered adults
• Third level
487,561 opposite-sex married spouses
Fourth level
• 56,807 opposite-sex unmarried partners
Fifth level
• 667 same-sex spouses
• 4,005 same-sex unmarried partners
Health Insurance
• Policy holder: Employer-sponsored insurance (ESI)
• Dependent: Employer-sponsored insurance (ESI)
• Directly Purchased from Insurer
• Public Insurance (Medicaid & Medicare)
• Uninsured
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11. Methods
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• Trends in uninsurance by relationship type
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Second level
Third level
• Distributional changes in insurance coverage type
Fourth level
Fifth level
• Multivariate analysis
•
•
Logistic regression analysis estimating odds of uninsurance
Adjusted for age, race and ethnicity, education, poverty status, employment,
region, presence of a child in household, health status and year
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12. Uninsurance increases among most couples
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Click Different-Sex Married styles
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40%
35%
30%
25%
Same-Sex Men
Second level
Third level
32%
Different-Sex Unmarried
Same-Sex Women
33%
34%
Fourth level
Fifth level
34%
24%
21%
18%
20%
20%
18%
17%
15%
16%
10%
12%
13%
13%
1997-2000
2001-2004
2005-2008
18%
14%
5%
2009-2012
Notes: Same-sex couples include all adults that identify another person in the household of the same sex as a husband,
wife or unmarried partner. Source: National Health Interview Survey, 1997-2012.
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13. Men in to edit Master title style likely to
Click same-sex relationships less
have ESI as policy holders
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70%
60%
Second level
Third level
Fourth level
Fifth level
50%
40%
30%
21%
1997-2000
58%
2009-2012
50%*
24%
20%
9%
10%
12%
7%
4%
5%
9% *
0%
Uninsured
ESI Policy
Holder
ESI Dependent
Directly
Purchased
Public
Source: National Health Interview Survey, 1997-2012.
Notes: * indicates p<0.05; **p<0.01
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14. Women inedit Master title stylemore likely
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to have ESI as a dependent
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60%
50%
Second level
56% 55%
Third level
1997-2000
2009-2012
Fourth level
Fifth level
40%
30%
20%
20%
18%
12%
14%
10%
4% 3%
7%
11%
0%
Uninsured
ESI Policy
Holder
ESI Dependent
Directly
Purchased
Public
Source: National Health Interview Survey, 1997-2012.
Notes: * indicates p<0.05; **p<0.01
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15. Odds Ratio of Being Uninsured, Men
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Opposite-Sex Married
Same-Sex
Click to edit Master text stylesUnmarried
Second level
Same-Sex Married
3.14 *
Third level
2.65*
Fourth level
Fifth level
1.71
1.00
1997-2000
1.00
2009-2012
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16. Odds Ratio of Being Uninsured, Women
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Opposite-Sex Married
Same-Sex
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Same-Sex Married
Second level
2.98
Third level *
Fourth level
Fifth level
1.71 *
1.34
1.00
1997-2000
1.00
2009-2012
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17. Key Findings
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• Uninsurance has been increasing for all
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couples—except for women in same-sex
Second level
relationships
Third level
Fourth level
adultslevel same-sex
in
Fifth
•
More
relationships are
covered by another person’s health plan as a
dependent
•
Unmarried same-sex couples still more likely to
be uninsured
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18. Click to Gilbert Gonzales, MHA
edit Master title style
Click to edit Master textPhD Student
styles
Second level
Third level
Graduate Research Assistant
gonza440@umn.edu
Fourth level
Fifth level
University of Minnesota
School of Public Health
Division of Health Policy & Management
www.shadac.org
@shadac